As the Covid-19 pandemic rages on, we continue to discover more about how the respiratory virus works and all the complications it can cause. And while complications such as heart failure are an already-documented common problem, there are also very serious brain problems discovered in some coronavirus patients.
Peculiar neurological ailments such as loss of smell (anosmia) and loss of taste have been well-known for a while but newer rare symptoms such as seizures, confusion, and strokes are also being discovered.
One such example was a 74-year-old man in early March who visited an emergency room with a cough and a fever. The man went through an X-ray that ruled out pneumonia so he was sent home. However, the next day his fever got worse and the man’s family brought him back to the hospital. This time he had also lost the ability to speak and appeared to be having a seizure.
Another, more recent case, came from Detroit at the end of March. Doctors there reported that a female airline worker in her 50s tested positive for coronavirus. She also had a headache and experienced mild confusion. She was aware enough to tell the doctors her name but she could tell them almost nothing else about herself.
As time went by she became even less responsive and the physicians performed a brain scan. The results from the scan showed abnormal swelling and inflammation in multiple regions of her brain as well as entire smaller regions with dying brain cells – a condition known as “acute necrotizing encephalopathy” that’s a rare complication of influenza and other similar viral infections.
Dr. Elissa Fory, a neurologist with Henry Ford Health System, commented about the patient’s rare condition that “The pattern of involvement, and the way that it rapidly progressed over days, is consistent with viral inflammation of the brain, This may indicate the virus can invade the brain directly in rare circumstances.”
So far, the patient remains in critical condition.
There’s also been similar reports about bizarre and rare neurological conditions related to Covid-19 from around the globe. Blood clots, numbness in the limbs (acroparesthesia), as well as strokes, seizures, and encephalitis-like symptoms have been reported.
Some patients have been seen as becoming delirious before their fevers or respiratory problems worsened. Dr. Alessandro Padovani, whose hospital at the University of Brescia in Italy opened a whole new “NeuroCovid” unit to take care of coronavirus patients with neurological conditions.
Encephalopathy is an especially troubling problem. Patients with this problem are confused, lethargic, and seemingly dazed. They tend to exhibit strange behavior such as staring emptily into space. Seizures are also a problem for such patients and they should be brought to a medical facility as quickly as possible.
Why do such neurological problems happen to some Covid-19 patients?
There is much we still don’t know about the connection between the novel coronavirus and neurological complications such as these ones.
Dr. Sherry H-Y. Chou, a neurologist at the University of Pittsburgh School of Medicine is investigating the phenomena with a team from the Neurological Care Society. According to her, “We absolutely need to have an information finding mission, otherwise we’re flying blind. There’s no ventilator for the brain. If the lungs are broken we can put the patient on a ventilator and hope for recovery. We don’t have that luxury with the brain.”
Thankfully, most Covid-19 patients tend to have no neurological complications. Dr. Robert Stevens, a neurologist at the Johns Hopkins School of Medicine in Baltimore is also tracking these problems and he has commented that “Most people are showing up awake and alert, and neurologically appear to be normal,”
According to him and other neurological specialists, it’s too early to make any definitive statements about the relationship between Covid-19 and the developing or worsening of certain rare neurological conditions but the situation will continue to be monitored.
Another factor to be considered is a recent study where the researchers mentioned that other coronaviruses aren’t always confined to the respiratory tract and are known to invade the central nervous system as well. The authors of the paper commented that this may play a role in acute respiratory failure in Covid-19.
Still, Dr. Stevens emphasized that it’s just too early to tell. As he puts it, “It could be as simple as low levels of oxygen in the bloodstream,” resulting from respiratory failure, along with an increase in carbon dioxide, which “can have a significant impact on the function of the brain, and lead to states of confusion and lethargy,”
Dr. Stevens also added that “We are still in the early days of this, and we don’t really know for sure.”
When do we first notice such neurological complications?
This isn’t a new development either as the first cases of neurological problems in Covid-19 patients date as far as back as the beginning of the pandemic in February when neurologists from Wuhan, China talked about them in another research paper.
Since then, similar reports have been coming from Germany, Italy, Austria, Holland, and France, as well as the U.S.
Dr. Stevens also points out that such problems are not limited to patients over 60-years of age either, and have been observed in younger patients too. There have even been cases of asymptomatic Covid-19 patients who weren’t exhibiting any of the standard coronavirus symptoms but experienced altered mental state and problems nevertheless. Neurologists point out that it’s important for such patients to always be tested for Covid-19 regardless of whether they are symptomatic or not.
This was perfectly exemplified by a recent case from Danbury Hospital in Connecticut where four elderly patients came into the hospital with encephalopathy. All 4 of them were asymptomatic for coronavirus but tested positive with the encephalopathy being their only symptom.
Dr. Paul Nee is an infectious disease specialist at the hospital and he shared two of the patients also eventually developed fevers and required assisted breathing while the other two didn’t. And while it’s not uncommon for elderly people to exhibit confusion, Dr. Nee commented that “the striking thing is we have not seen any real respiratory illness in these patients.” And because the patients continue to test positive, they can’t be discharged even though they are otherwise asymptomatic.
There are also earlier reports that suggest that symptomatic patients are nevertheless more likely to exhibit any of the rare neurological conditioners such as headaches, dizziness, strokes, musculoskeletal injuries, or impaired consciousness. The study from February reported that ~15% of severely ill patients also experienced changes in their mental conditions compared to only 2.4% of asymptomatic patients or patients with more mild symptoms.
Another late March study published in the British Medical Journal discovered that out of 113 patients who died of Covid-19, 25 of them (22%) experienced neurological disorders such as somnolence or even falling into a coma.
Such neurological symptoms have also been achknowledged by the Center for Disease Control and Prevention (CDC) who have now added “new confusion or inability to rouse” as Covid-19 symptoms and warning signs.
Dr. Jennifer Frontera, a neurologist at N.Y.U. Langone Health who works with Dr. Chou also says that encephalopathy patients exhibiting confusion and a lack of alertness are very prone to seizures and should be treated as quickly as possible and with extra care.
“Seizures are not always big things where people fall down and are shaking on the ground,” Dr. Frontera said. “Some could be just veering off, not paying attention, making repetitive non-purposeful movements, or just mental status changes where people are just not themselves.”
Even with no seizures, patients who are in the risk groups should remain aware of the other possible mental symptoms and complications of Covid-19 and take extra care of protecting themselves from the disease.
“You don’t feel your best when you have a fever, but you should be able to interact normally,” Dr. Frontera said. “You should be able to answer questions and converse in a normal fashion.”
She also added that “I don’t want everyone calling 911 because they’re overly concerned. We just don’t have the capacity. But if someone is really out of it, they probably need medical attention.”